MDMA (Ecstasy or Molly)

What Is MDMA (Ecstasy or Molly)?

MDMA, short for 3,4-methylenedioxymethamphetamine, is most commonly known as “Ecstasy” or “Molly.” It is a manmade drug that produces energizing effects similar to the stimulant class amphetamines as well as psychedelic effects, similar to the hallucinogen mescaline. MDMA is known as a “club drug” because of its popularity in the nightclub scene, at “raves” (all-night dance parties), and music festivals or concerts.

MDMA is a Schedule I substance, which means that it is considered by the U.S. Federal government to have no medical benefit and a high potential for abuse. However, researchers continue to investigate the possible medical benefits for patients with post-traumatic stress disorder (PTSD) and terminal cancer patients with anxiety.

How Is MDMA (Ecstasy or Molly) Used?

Most people who use MDMA take it in a pill, tablet, or capsule. The pills can be different colors and sometimes have cartoon-like images on them. Some people take more than one pill at a time, called “bumping.” The popular term “Molly” (slang for “molecular”) refers to the pure crystalline powder form of MDMA, usually sold in capsules.

Researchers have found that much of the Ecstasy used today contains other drugs in addition to MDMA, which themselves can be harmful. Makers of MDMA might add caffeine, dextromethorphan (found in some cough syrups), amphetamines, PCP, or cocaine to the pills, tablets, or capsules. Frequently, they substitute other chemicals for MDMA, such as synthetic cathinones, the chemicals in “bath salts.”

MDMA’s effects generally last from 3 to 6 hours. It is common for users to take a second dose of the drug as the effects of the first dose begin to fade. Some users may also take MDMA along with other drugs.

How Does MDMA Affect the Brain?

Once the pill or capsule is swallowed, it takes about 15 minutes for MDMA to enter the bloodstream and reach the brain. MDMA produces its effects by increasing the activity of three neurotransmitters (the chemical messengers of brain cells): serotonin, dopamine, and norepinephrine.

The serotonin system plays a role in controlling our mood, aggression, sexual activity, sleep, and feeling of pain. The extra serotonin that is released by MDMA likely causes mood-lifting effects in users. People who use MDMA might feel very alert, or “hyper,” at first. Some lose a sense of time and have other changes in perception, such as a more intense sense of touch. Serotonin also triggers the release of the hormones oxytocin and vasopressin, which play a role in feelings of love, sexual arousal, and trust. This may be why users report feeling a heightened sense of emotional closeness and empathy.

Some users experience negative effects. They may become anxious and agitated, become sweaty, have chills, or feel faint or dizzy.

Even those who don’t feel negative effects during use can experience negative aftereffects. These aftereffects are caused by the brain no longer having enough serotonin after the surge that was triggered by using MDMA. Days or even weeks after use, people can experience confusion, depression, sleep problems, drug craving, and anxiety.

Effects of Long-Term Use

Researchers are not sure if MDMA causes long-term brain changes in people, or whether the effects are reversible when someone stops using the drug. However, studies have shown that some heavy MDMA users experience problems that are long lasting, including confusion, depression, and problems with memory and attention.

Because MDMA does not always break down in the body, it can interfere with its own metabolism. This can cause harmful levels of the drug to build up in the body if it is taken repeatedly within short periods of time. High levels of the drug in the bloodstream can increase the risk for seizures and affect the heart's ability to beat normally.

Can You Get Addicted to MDMA (Ecstasy or Molly)?

Researchers don’t yet know. What is known is that MDMA targets the same neurotransmitters that are targeted by other addictive drugs. Researchers are still working to understand MDMA’s addictive properties. But, some users experience:

Dependence—continued use despite understanding the harm it can cause

Withdrawal—symptoms that occur after regular use of the drug is reduced or stopped, such as fatigue, loss of appetite, depression, and trouble concentrating

Tolerance—the need for more of the drug to get the same “high” feeling

Can You Die From MDMA Use?

Yes, you can die from MDMA use. MDMA can cause problems with the body’s ability to regulate temperature, particularly when it is used in active, hot settings (like dance parties or concerts). On rare occasions, this can lead to a sharp rise in body temperature (known as hyperthermia), which can cause liver, kidney, or heart failure or even death.